1861517088 NPI number — PARADIGM, INC.

Table of content: (NPI 1861517088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861517088 NPI number — PARADIGM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADIGM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861517088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31091
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27833-1091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-561-8112
Provider Business Mailing Address Fax Number:
252-561-7455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 OLD PACTOLUS RD # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-0701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-561-8112
Provider Business Practice Location Address Fax Number:
252-561-7455
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
JASON
Authorized Official Middle Name:
TREMAIN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
252-714-1230

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-074-136 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8301107 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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